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War, Exile, Moral Knowledge and the Limits of Psychiatric Understanding: A Clinical Case Study of a Bosnian Refugee in London

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  • Derek Summerfield

Abstract

Background : This paper describes a Bosnian refugee, a survivor of war and ethnic cleansing, during a 3-year follow-up in a psychiatry clinic. Discussion : This case throws light on the tension between medicotherapeutic and sociomoral ways of understanding the effects of such experiences, and of the limitations of morally and politically neutral psychiatric categories and technologies. Suffering always invokes questions of values: in this case the clinical picture represented a moral protest at what had been done with such impunity, and a refusal to accommodate to a world which now seemed unintelligible. The clinical picture also embodied the collective outrage, and sense of unfinished business, which many back in Bosnia itself were carrying in the wake of the 1995 Dayton peace accords which effectively legitimised the lines of ethnic cleansing. Conclusions : DSM or ICD diagnoses of depressive disorder or post-traumatic stress disorder turned out to lack validity and explanatory power. Claims that victims of war and atrocity typically have an unmet need for mental health services are overstated. Recovery from the effects of war may depend on reestablishing a sense of intelligibility, a task that must primarily go on in social space rather than mental space.

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  • Derek Summerfield, 2003. "War, Exile, Moral Knowledge and the Limits of Psychiatric Understanding: A Clinical Case Study of a Bosnian Refugee in London," International Journal of Social Psychiatry, , vol. 49(4), pages 264-268, December.
    • Handle: RePEc:sae:socpsy:v:49:y:2003:i:4:p:264-268
    DOI: 10.1177/0020764003494004
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    1. Summerfield, Derek, 1999. "A critique of seven assumptions behind psychological trauma programmes in war-affected areas," Social Science & Medicine, Elsevier, vol. 48(10), pages 1449-1462, May.
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    1. Hinton, Devon E. & Rasmussen, Andrew & Nou, Leakhena & Pollack, Mark H. & Good, Mary-Jo, 2009. "Anger, PTSD, and the nuclear family: A study of Cambodian refugees," Social Science & Medicine, Elsevier, vol. 69(9), pages 1387-1394, November.
    2. Pushpa Kanagaratnam & Joanna Anneke Rummens & Brenda TonerVA, 2020. "“We Are All Alive . . . But Dead†: Cultural Meanings of War Trauma in the Tamil Diaspora and Implications for Service Delivery," SAGE Open, , vol. 10(4), pages 21582440209, October.

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